1. Rotherham Social Prescribing – Our Story so far
Ruth Nutbrown, Assistant Chief Officer, NHS Rotherham Clinical Commissioning Group
Dr Richard Cullen, Lead Commissioning GP , NHS Rotherham Clinical Commissioning Group
Janet Wheatley , Chief Executive, Voluntary Action Rotherham
Hello, my name is Ruth Nutbrown, along with my colleagues Dr Richard Cullen and Janet Wheatley we’d like to take you through our story……our story started back in April 2012 with the Rotherham Social Prescribing Pilot delivered by Voluntary Action Rotherham (VAR) on behalf of NHS Rotherham CCG as part of a wider GP-led Integrated Case Management Pilot and aimed to increase the capacity of GP practices to meet the non-clinical needs of their patients with long term conditions (LTCs). The pilot received around £1m as part of a programme to provide 'additional investment in the community'

2. Why are we doing it?- Commissioning perspective
Huge efficiency challenge - £75m over 4 years
Increasing numbers with long term conditions
Above average unplanned hospital admissions
Recognition that patients need support with non-medical issues - creates a wider range of options for primary care and patient
Shift of focus to prevention and early intervention - increases independence, resilience of individuals and communities
Supports integration and personalisation
Doing things differently – ‘more of the same’ is not an option
The public health white paper “healthy lives, healthy people” stressed it wasn’t better treatment, but prevention –both primary and secondary which is more likely to deliver greater overall increases in healthy life expectancy.
The Rotherham social prescribing model particularly focusses on secondary prevention, commissioning service that will prevent worsening health for those people with existing LTCs and therefore reducing costly interventions.
We already target the top 5% of people at risk of hospitalisation using admission risk stratification and GP judgement and we intend to expand this to target the top 10% at risk people as our patient level evaluation conducted by the Centre for Regional Economic and Social Research at Sheffield Hallam University has shown this cohort will benefit from the service.
Extending our social prescribing service to cover mental health clients was a natural progression for this model of partnership working between primary care and the voluntary sector.

3. The Leap of Faith…..
Voluntary sector challenged to reduce admissions to hospital
Open thinking by commissioners prepared to take a risk
CCG / VAR had a track record of working together over numerous years
VAR acts as a conduit to wider Voluntary and Community Sector
VAR offered the CCG one contract/accountable body- VAR can manage multiple small scale contracts with diverse providers as part of SPS delivery
Added value/ripple effect of investing in/ working with the VCS

4. What impact is it having -Commissioning perspective
Inpatient admissions reduced by 21%
A&E attendance reduced by as much as 20%
Outpatient appointments reduced by as much as 21%
ROI could reach £3.38 per pound. If the benefits being achieved by the end of the pilot are sustained over a five year period.
The figures from the pilot speak for themselves. In addition the value of patients’ wellbeing benefits was estimated as between £819,000 and £920,000 by the end of the pilt.

5. Why are we doing it – the GP Perspective

6. The challenge for GPs…………………
How do we make you feel better?

7. “Life Makes you Feel Unwell”

8. Our Solution Social Prescribing Case Managed by GP’s

9. “Life gives you a label”

10. Why are we doing it? The VCS Perspective
Estimated 1382 voluntary and community organisations in Rotherham
There are 49,000 volunteers.
The Sector works across all ages/ geographical communities/ communities of interest/ areas of work
64% improve peoples mental well being
61% address the needs of the most disadvantaged
53% increase peoples skills
49% help people feel they belong to the their neighbourhood
Support VCS own delivery & sustainability, Use their contribution in service transformation, Provide significant additional value and Improve outcomes for Individuals/ Communities
The VCS can offer support in the following areas domains:
Condition management programmes
Health and well-being
Support to access or maintain employment, education or wider community participation:
Emotional and practical support:
Volunteering opportunities
They provide flexible, locally appropriate services that help individuals with various aspects of their self-management, improve their health& wellbeing and contribute to their care and support planning .
The sector has potential to provide alternative, flexible, innovative, cost effective models to engagement and service delivery with communities, individuals, patients/ carers.
We wanted to capitalise on this to support VCS own delivery & sustainability, recognise their role/ contribution in service transformation, provide significant additional value and most important improve outcomes for individuals/ communities

11. Social Prescribing Strengthening individuals, strengthening communities
Provides a framework for:
Connecting people with long term conditions, referred through case management teams, to sources of support in their community
Risk Stratification identifies top 3% of patients at risk of hospitalisation 3-5% identified using risk stratification and GP Clinical Judgement
Patients referred to Multi Disciplinary Team of GP’S, Practice Nurses/ District Nurses/ Community Matrons/ Social Worker and VAR VCS SPS Advisor
VAR manages the contract & employs SPS Advisor linked to each GP practice to support the MDT to find community activities that meet patient needs
Rotherham SPS started April 2012 first referrals September st April 2015 extended to a pilot project working with RDASH mental health teams.
PRESCRIPTION
Exercise / healthy lifestyles
Self-management programmes
Social and leisure
Arts and crafts
Befriending/mentoring
Confidence building
Learning/training
Money – benefits, debt, fuel poverty
Housing/adaptations
Carers support
Dementia support
Transport/mobility
Advocacy

12. Key facts and figures
5000 referrals into SPS GP Scheme (approx. 115 per month)
250 referrals to SPS Mental Health scheme ( approx. 15 per month)
51% aged 80+ LTC SPS
16% aged under 65 LTC SPS
95% aged under 65 MH SPS
5% BME LTC SPS
Highest category of support
Befriending – 28% - 44% MHSPS
Carer Respite -13%
Advocacy & Support – 12%
Advice & Info/ Community Hubs
Dementia Services – 11%
Befriending Plus (bef + enab) 28%
Carer Respite 13%
Advocacy & Support %
Advice & Information 11%
Community Hubs 11%
Dementia services 11%
Activity Group Pathways 4%
Therapeutic (individuals) 4%
Therapeutic (group) 2%

13. What Impact has this had for the Voluntary and Community sector (VCS)
Social Prescribing (SPS) is a route into the Voluntary and Community Sector -for many it is an important first step to engaging VCS services and wider statutory provision
It is an excellent example of co-production – SPS has been developed with VCs organisations, service users/ carers/ and health staff
SPS is an integral to supporting user of health services to be active not passive recipients in their own health and recovery- it supports self care, increased independence
SPS has increased awareness of the VCS - it has changed ways of working, build relationships with health, it is changing cultures and breaking down professional barriers
SPS supports VCS potential to provide innovative , flexible, trusted non clinical packages of support - the VCS is a vital element in locally developed integrated approach to patient centred care, prevention, recovery and discharge. It changes a discussion from ‘what’s the matter with’ you to ‘what matters to you’

14. What Impact has this had for the Voluntary and Community sector (VCS)
VAR through SPS supports the VCS to deliver services through a mixed commissioning funding model – it’s a model of local micro commissioning that helps the sustainability of the sector.
SPS has to work with the groups as well at the patients – this is the added value of the work VAR does
It has led to the development of new provision/ flexibility in existing provision - it has brought in additional financial resources and led to new opportunities for the VCS
It has increased VCS collaboration, impacted on volunteering – supported service users to become service volunteers
It has enabled VCS groups and their service users to have a greater voice in design and delivery of services –it has demonstrated the impact on health and social care outcomes and spending

15. It is a win/win!!
The CCG benefits, as it addresses inappropriate admissions.
The GP’s benefit, as it gives them a third option other from referral to hospital or to prescribe medication.
The Voluntary and community sector benefit, as it supports their sustainability.
And most importantly - the Patient and Carers love it as it improves quality of life, reduces social isolation and moves the patient from dependence to independence.
Our National award winning social prescribing service was highlighted in the Five Year Forward View as exceptional practice, saving money and improving outcomes. Social prescribing is the focus of the CCG’s Targeted prevention and early intervention programme, as shown in Rotherham’s Integrated Health and Social Care Place Plan.

16. Contact Details
Ruth Nutbrown – Assistant Chief Officer, NHS Rotherham Clinical Commissioning Group
Dr Richard Cullen - Lead Commissioning GP , NHS Rotherham Clinical Commissioning Group
Janet Wheatley- Chief Executive, Voluntary Action Rotherham (VAR)

17. Case Studies
Link to DVD